title: Dose evaluation and risk estimation for secondary cancer in contralateral breast and a study of correlation between thorax shape and dose to organs at risk following tangentially breast irradiation during deep inspiration breath-hold and free breathing.
abstract: OBJECTIVE
  To assess the impact of using breathing adapted radiotherapy on contralateral breast (CB) dose, to relate the thorax shape with the dose to the organs at risk (OARs) and to predict the risk for induced malignancies in CB using linear and non-linear models, following tangential irradiation of breast.
  
  
  METHODS
  Sixteen patients with stage I-II breast cancer treatment planned with tangential fields using deep inspiration breath hold (DIBH) and free breathing (FB) techniques were included in this analysis. The dose results mainly based on DVH analysis were compared. Four parameters were defined to describe thoracic shape. Excess relative risk (ERR) for cancer induction in CB, employing linear and non-linear models was calculated.
  
  
  RESULTS
  Average CB volumes exposed to a dose of 1 Gy is 1.3 times higher in DIBH plans than in FB plans. No significant difference in average V3Gy and V5Gy for DIBH and FB plans is observed. The average mean CB dose for DIBH and FB plans is 0.33 and 0.28 Gy, respectively. No correlation between thorax shape parameters and mean OARs dose is observed. The estimated average mean ERR with linear model is lower in FB plans (0.12) than for the DIBH plans (0.14). The estimated ERR with non-linear model is 0.14 for DIBH plans and 0.15 for FB plans.
  
  
  CONCLUSIONS
  No significant difference in CB dose between DIBH and FB plans is observed. The four thorax shape parameters defined in this study can not be related to the dose at OARs using DIBH and FB radiation techniques. The ERR estimates for secondary CB cancer are nearly the same for FB and DIBH planning when using a linear and non-linear risk prediction models.
authors.affiliation: Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. Safora.Johansen@Radiumhospitalet.no
authors.forename: Safora
authors.initials: S
authors.lastname: Johansen
authors.forename: Johan
authors.initials: J
authors.lastname: Vikström
authors.forename: Mari Helene Blihovde
authors.initials: MH
authors.lastname: Hjelstuen
authors.forename: Ingvil
authors.initials: I
authors.lastname: Mjaaland
authors.forename: Kjell Ivar
authors.initials: KI
authors.lastname: Dybvik
authors.forename: Dag Rune
authors.initials: DR
authors.lastname: Olsen
mesh_terms: D001943:Breast Neoplasms / Q000150:complications / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D001239:Inhalation; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology*; D058958:Organs at Risk; D011379:Prognosis; D011832:Radiation Injuries / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012307:Risk Factors; D013909:Thorax / Q000528:radiation effects*